A recent increase in SPMI among women of childbearing age highlights the importance of care coordination among nurses, obstetric providers, and psychiatrists

Washington, DC – December 20, 2016 – A recently published article in Nursing for Women’s Health (NWH), a journal of the Association of Women’s Health, Obstetric and Neonatal Nurses(AWHONN), highlights the potential consequences of severe and persistent mental illness (SPMI) during pregnancy, and the increase in rates of SPMI among women of childbearing age, both of which pose challenges to nurses and other health care providers.

In the United States, SPMI affects 1 in 17 people. Recently, clinicians have seen an increase in SPMI among women of childbearing age and researchers anticipate that rates will continue to rise in coming years.

Women with SPMI are often hesitant to disclose their conditions to health care professionals due to the perceived stigma often associated with mental health disorders. Consequently, clinicians do not have as much experience or training treating pregnant women with SPMI. “Assessment and Care of Childbearing Women with Severe and Persistent Mental Illness” aims to address this gap and explains how clinicians can take appropriate actions to accurately diagnose and manage treatment for pregnant women with SPMI. The paper is authored by Amy McKeever, PhD, CRNP, WHNP-BC, SueEllen Alderman, RN, MSN, PMHCS, Stephanie Luff, BSN, RN, and Brian DeJesus, MSN, RN, and is featured in the October/November 2016 issue of NWH.

The most vulnerable time for pregnant women with SPMI is the perinatal period, the time shortly before and after birth, so it is critical for nurses and other health care professional to recognize this and provide appropriate support. Because nurses are often the first point of contact within the health care system for pregnant women, they have the first opportunity to ensure that pregnant women with SPMI are receiving the care they need. By monitoring for symptoms of SPMI, nurses can ensure that symptoms are appropriately diagnosed and treated. Nurses also play a role in coordinating care between psychiatric and obstetric clinicians to assess treatment plans.

A second critical time for pregnant women with SPMI is the intrapartum period, or during labor and childbirth, when increased anxiety is common. The authors stressed the importance of pharmacological pain management during this period to reduce the risk of psychosis from fear, stress or pain.

In the postpartum period, women with preexisting SPMI are more likely to experience postpartum depression. For women with major depressive disorder, the probability may be upwards of 50%. Nurses are well-positioned to detect symptoms of postpartum depression, including persistent feelings of sadness, worthlessness, anxiety and a lack of interest in the baby, among others.

The NWH authors describe several practical implications for clinicians to incorporate into their practice to ensure pregnant women with SPMI receive the best possible care. First, care providers must take an interdisciplinary approach to the complex process of assessment, diagnosis and management. Second, all women of childbearing age who are admitted for in-patient psychiatric treatment should be screened for pregnancy, in accordance with psychiatric care guidelines. When a woman with SPMI is pregnant, clinicians should prescribe a medication regimen that provides the most effective treatment with the lowest risk of fetal harm. The authors further recommend the development of new guidelines to include assessment of women for SPMI during the prenatal, intrapartum and postpartum periods.

“As rates of SPMI among childbearing women rise, it is increasingly important for nurses to be educated about these disorders and aware of the various approaches to treatment,” said AWHONN CEO, Lynn Erdman, MN, RN, FAAN. “The nurses of AWHONN are committed to working within an interdisciplinary team to ensure that these women are properly diagnosed and treated.”

Nursing for Women's Health is a bimonthly refereed clinical practice journal of the Association of Women's Health, Obstetric and Neonatal Nurses. The journal circulates to more than 25,000 nurses who care for women and newborns and is available online athttp://nwhjournal.org.

About AWHONN

Since 1969, the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) has been the foremost authority promoting the health of women and newborns and strengthening the nursing profession through the delivery of superior advocacy, research, education, and other professional and clinical resources. AWHONN represents the interests of 350,000 registered nurses working in women's health, obstetric, and neonatal nursing across the United States. Learn more about AWHONN atwww.awhonn.org.

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